Mycobacterium avium Complex: Addressing Gaps in Diagnosis and Management

被引:44
作者
Daley, Charles L. [1 ]
Winthrop, Kevin L. [2 ]
机构
[1] Natl Jewish Hlth, Div Mycobacterial & Resp Infect, Dept Med, Med, Denver, CO 80206 USA
[2] Oregon Hlth & Sci Univ, Infect Dis, Sch Med, Sch Publ Hlth,Publ Hlth, Portland, OR 97201 USA
关键词
diagnosis; Mycobacterium avium complex; pulmonary disease; refractory disease; risk factors; treatment; NONTUBERCULOUS MYCOBACTERIA; LUNG-DISEASE; THERAPY; INFECTION; RISK; PREVALENCE; ONTARIO; OREGON; CANADA;
D O I
10.1093/infdis/jiaa354
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and an important cause of disease. The most common species causing pulmonary disease are members of Mycobacterium avium complex (MAC). MAC pulmonary disease (MAC-PD) can be chronic, debilitating, costly, and associated with a high mortality. However, MAC diagnoses are often delayed due to the nonspecific presentation of MAC-PD and radiological findings that overlap with other pulmonary diseases. Patients with risk factors and who meet the diagnostic criteria-which include clinical, radiological, and microbiologic criteria-should be considered for treatment. Diagnosis requires 2 or more positive sputum cultures or 1 bronchoscopic specimen culture. The recommendation for those who are treated is a 3-drug regimen including macrolide, rifamycin, and ethambutol that is continued for 12 months beyond sputum culture conversion to negative. MAC-PD is difficult to treat, with frequent drug-related side effects and suboptimal treatment outcomes. Refractory and recurrent disease is common, leading to lifelong follow-up of patients. There are limited treatment options for patients with macrolide-resistant or refractory disease. Amikacin liposome inhalation suspension is recommended for treatment-refractory patients whose cultures remain positive after 6 months of guideline-based therapy. Among the research priorities to improve patient outcomes and quality of life are developing new, more rapid diagnostic tests, investigating biomarkers associated with disease progression, and identifying new drugs and routes of administration as well as new, shorter, and better-tolerated regimens.
引用
收藏
页码:S199 / S211
页数:13
相关论文
共 53 条
[1]   Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis [J].
Andrejak, Claire ;
Nielsen, Rikke ;
Thomsen, Vibeke O. ;
Duhaut, Pierre ;
Sorensen, Henrik Toft ;
Thomsen, Reimar Wernich .
THORAX, 2013, 68 (03) :256-262
[2]  
[Anonymous], 2018, ARIKAYCE AM LIP INH
[3]   Relapse versus Reinfection of Mycobacterium avium Complex Pulmonary Disease Patient Characteristics and Macrolide Susceptibility [J].
Boyle, Daniel P. ;
Zembower, Teresa R. ;
Qi, Chao .
ANNALS OF THE AMERICAN THORACIC SOCIETY, 2016, 13 (11) :1956-1961
[4]  
Clinical and Laboratory Standards Institute, 2018, M100 CLSI
[5]  
ClinicalTrials.gov, NONT MYC INF STUD
[6]  
Daley CL, 2020, CLIN INFECT DIS, V71, pE1, DOI 10.1093/cid/ciaa241
[7]   Environment or Host? A Case-Control Study of Risk Factors for Mycobacterium avium Complex Lung Disease [J].
Dirac, M. Ashworth ;
Horan, Kathleen L. ;
Doody, David R. ;
Meschke, J. Scott ;
Park, David R. ;
Jackson, Lisa A. ;
Weiss, Noel S. ;
Winthrop, Kevin L. ;
Cangelosi, Gerard A. .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2012, 186 (07) :684-691
[8]   Pathological findings of bronchiectases caused by Mycobacterium avium intracellulare complex [J].
Fujita, J ;
Ohtsuki, Y ;
Shigeto, E ;
Suemitsu, I ;
Yamadori, I ;
Bandoh, S ;
Shiode, M ;
Nishimura, K ;
Hirayama, T ;
Matsushima, T ;
Fukunaga, H ;
Ishida, T .
RESPIRATORY MEDICINE, 2003, 97 (08) :933-938
[9]   An official ATS/IDSA statement: Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases [J].
Griffith, David E. ;
Aksamit, Timothy ;
Brown-Elliott, Barbara A. ;
Catanzaro, Antonino ;
Daley, Charles ;
Gordin, Fred ;
Holland, Steven M. ;
Horsburgh, Robert ;
Huitt, Gwen ;
Iademarco, Michael F. ;
Iseman, Michael ;
Olivier, Kenneth ;
Ruoss, Stephen ;
von Reyn, C. Fordham ;
Wallace, Richard J., Jr. ;
Winthrop, Kevin .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2007, 175 (04) :367-416
[10]   Mycobacterium avium Complex and Bronchiectasis There's Something Happening Here ... [J].
Griffith, David E. ;
Aksamit, Timothy R. .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2018, 198 (10) :1252-1253